Author(s), Year | Subjects and Setting; Number (n) Enrolled | Interventions; Number (n) of Subjects | Comparisons; Number (n) of Subjects | Follow-up | Outcomes | Key Findings |
---|---|---|---|---|---|---|
Bergman et al., 2004 [51] | Participants (=18 y.o) recruited from general practices in Groningen, the Netherlands. | Manual therapy and usual care: | Usual care: | 12 (immediately post-intervention), 26 and 52 weeks | Primary outcomes: | Patient-perceived recovery (manual therapy and usual care vs. usual care): |
Case definition: Pain of variable duration between the neck and elbow at rest or during movement of the upper arm; physical examination confirming shoulder symptoms and dysfunction in the cervicothoracic spine and ribs with accompanying pain or restricted movement (n=150) | Manual therapy (up to 6 sessions over 12 weeks) by physiotherapists: manipulations and mobilization to the cervical spine, upper thoracic spine, and adjacent ribs. | Usual care (information, advice, and therapy) as outlined by the Dutch College of General | Self-perceived recovery (7point Likert scale; recovered = “completely recovered” or “very much improved”) | Proportion of participants reporting themselves ‘completely recovered’ or ‘verymuch improved’ (reference group: usual care)a: | ||
Usual care (information, advice, and therapy) according to the Dutch College of General | Practitioners provided by GPs: delivered following same protocol as in manual therapy and usual care group (n=71) | Cure rate (self-report of shoulder symptom improvement to a point where they are no longer inconvenient) | 12 weeks: RR 2.0 (95% CI 1.2, 3.4) | |||
26 weeks: RR 1.2 (95% CI 0.8, 1.7) | ||||||
Practitioners provided by GPs: | ||||||
52 weeks: RR 1.5 (95% 1.0, 2.2) | ||||||
Weeks 1–2: information about the nature and course of shoulder symptoms, advice on daily activities, prescription for oral analgesics or NSAIDs if necessary. | ||||||
Proportion of participants reporting symptom improvement to the point where they are no longer inconvenienta: | ||||||
12 weeks: RR 1.4 (95% CI 0.9, 2.0) | ||||||
26 weeks: RR 1.2 (95% CI 0.9, 1.8) | ||||||
52 weeks: RR 1.4 (95% CI 1.0, 1.9) | ||||||
Difference in mean change (manual therapy and usual care – usual care): | ||||||
Severity of main complaint (0–10) | ||||||
12 weeks: 1.5 (95% CI 0.5, 2.5) | ||||||
26 weeks: 1.2 (95% CI 0.2, 2.2) | ||||||
52 weeks: 1.4 (95% CI 0.4, 2.4) | ||||||
Shoulder disability (0–100) | ||||||
12 weeks: 8.5 (95% CI -2.0, 18.9) | ||||||
26 weeks: 12.7 (95% CI 1.3, 24.1) | ||||||
52 weeks: 6.9 (95% CI -3.5, 20.7) | ||||||
General health (3 point scale) | ||||||
No difference. | ||||||
Weeks 3–4: extension of prescription medication if necessary. | Secondary outcomes: severity of main complaint (NRS, 0–10); functional disability (SDQ, 0–100), quality of life (EuroQol, 5 items scored using 3-point ordinal scale, -1=worst; 1=best). | |||||
Weeks 5–6: Up to 3 subacromial or glenohumeral corticosteroid injections (40mg triamcinolone acetonide with or without 10mg lidocaine) | ||||||
Weeks 6–12: Physiotherapy shoulder exercises, massage and passive physical modalities were considered. (n=79) | ||||||
Cook et al., 2014 [52] | Patients (=18 y.o.) attending outpatient clinical/academic centers in the USA or South Africa. | Shoulder and neck treatment by physiotherapist: | Shoulder treatment by physiotherapist: | Immediately post-intervention [mean 56.1 days (SD 55.0)] | Primary outcome: Disability (QuickDASH, 0–100) | Difference in mean change (shoulder and neck treatment – shoulder treatment) a: |
Secondary outcome: Pain (NRS, 0–10), patient satisfaction and adaptation to symptoms (PASS, acceptable = unlikely to seek further treatment, unacceptable = likely to seek further treatment) | Disability (QuickDASH 0–100): | |||||
Case definition: Shoulder impingement syndrome (mean duration 11.7 weeks) with: 1) pain or dysfunction with overhead activities and active shoulder movements; 2) positive Neer/ Hawkins-Kennedy test; 3) onset =12 months; 4) painful arc; 5) baseline pain =2/10 (n=74) | ||||||
Neck treatment (duration and frequency of treatment determined by the physiotherapist): Grade III posterior-anterior mobilization (3 x 30 oscillations) to stiffest or most painful segments in the cervical spine or to the C5-C6, or C6-C7 segments on the same side of shoulder impingement if joint findings were absent. | Pragmatically delivered multimodal program of care including manual therapy stretching, isotonic strengthening, and restoration of normative movement. (n=36) | |||||
Post-intervention: 5.3 (95% CI -3.0, 13.6) | ||||||
Pain (NRS 0–10) | ||||||
Post-intervention: 0.5 (95% CI -0.6, 1.6) | ||||||
No difference in the proportion of participants considering their state ‘acceptable’ (unlikely to seek further treatment) a: | ||||||
Post-intervention: RR 0.92 (95% CI 0.73, 1.15) | ||||||
Multimodal shoulder care: manual therapy, stretching, isotonic strengthening, and restoration of normative movement. (n=38) | No adverse events reported. | |||||
Cleland et al., 2013 [53] | Patients (16–60 y.o.) with inversion ankle sprain presenting to physical therapy clinics in Colorado. | MTEX: | HEP: | 4 weeks (immediately post-intervention) and 6 months | Primary outcome: Disability (FAAM ADL subscale; 0–100). | Differences in mean change (MTEX-HEP): |
Manual therapy by physical therapist (2 x 30 minute sessions per week for 4 weeks): Grade I-IV mobilization (grade selected by therapist /patient tolerance) to the proximal tibiofibular joint, distal tibiofibular joint, talocrural joint, and subtalar joint. | Home exercises (daily): Instruction by a physical therapist (1 x 30 minute session per week for 4 weeks): same exercises as MTEX group | FAAM ADL (0–100): | ||||
Home exercises (daily): mobilizing exercises for the foot and ankle, gentle strengthening exercises, resistive-band exercises, 1-leg standing activities, standing on balance board, and weight-bearing functional activities; program progressed by physical therapist as indicated | ||||||
Advice to continue with activities that did not increase symptoms and avoid activities that aggravate symptoms. | ||||||
Education on ice, compression, and elevation. (n=37) | ||||||
1 month: 11.7 (95% CI 7.4, 16.1) | ||||||
6 months: 6.2 (95% CI 0.98, 11.5) | ||||||
Secondary outcomes: Disability (FAAM sports subscale; 0–100); Function (LEFS; 0–80); Pain (NRS; 0–10); global improvement (-7 to +7); recurrence | FAAM sports (0–100): | |||||
Case definition: grade 1 or 2 inversion ankle sprain as defined by the West Point Ankle Sprain Grading System; no restriction in days since injury; NRS = 3/10 in last week; negative Ottawa ankle rules. (n=74) | Advice to continue with activities that did not increase symptoms and avoid activities that aggravate symptoms | 1 month: 13.3 (95% CI 8.0, 18.6) | ||||
6 months: 7.2 (95% CI 2.6, 11.8) | ||||||
LEFS (0–80): | ||||||
1 month: 12.8 (95% CI 9.1, 16.5) | ||||||
6 months: 8.1 (95% CI 4.1, 12.1) | ||||||
Education on ice, compression, and elevation. (n=37) | NRS (0–10): | |||||
1 month: 1.2 (95% CI 0.9, 1.5) | ||||||
6 months: 0.47 (95% CI 0.05, 0.90) | ||||||
Global Improvement: | ||||||
Statistically significant difference in favor of MTEX at 1 and 6 months (p<0.001). | ||||||
Recurrencea | ||||||
No difference in the proportion of participants reporting recurrence of their injury at 6 months: | ||||||
RR 0.6 (95% CI 0.15; 2.33) | ||||||
No adverse events were reported. |